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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Longstanding untreated congenital torticollis in adults is uncommon and surgical release in such a case can be hazardous or fraught with many possible complications. A two-stage, open, bipolar surgical division of the contracted sternocleidomastoid muscle in a 33-year-old woman who developed pain and paresthesiae in the neck and arm was performed under general then local anesthesia. Surgery then controlled gradual stretching in a halo-vest achieved complete subsidence of pain, a near-full range of neck motion and correction of the tilt deformity, without complication. The facial asymmetry and the underlying fixed skeletal changes remained. Surgical release and gradual correction in a halo apparatus can eliminate the need for major spinal surgery in the correction of longstanding torticollis.
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PMID:Surgical release of congenital torticollis in adults. 65 10

Botulinum toxin A was administered to 19 patients with spasmodic torticollis. A significant decrease of abnormal head and neck movements was recorded, and all the patients who suffered pain reported relief. Side effects were minor and transient. The results of this study indicate that botulinum toxin is an effective means of treating torticollis.
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PMID:[Botulinum toxin treatment of spastic torticollis]. 141 92

We reviewed the efficacy and adverse effects of repeated botulinum toxin injections into hyperactive neck muscles of 107 successive patients with spasmodic torticollis. They received 510 injection treatments over a median period of 15 months (range 3-42 months). One patient failed to benefit at all, but 101 (95%) patients reported considerable (moderate or excellent) benefit from at least one treatment. On a global subjective response rating, 93% of 429 treatments resulted in some improvement and 76% in moderate or excellent improvement. Pain reduction followed 89% of 190 treatments with moderate or excellent reduction after 66%. Median duration of benefit was 9 weeks. All torticollis types responded equally well and injections into two (or more) involved neck muscles were more effective than injection into a single muscle. The most frequent adverse effect was dysphagia, occurring after 44% of all treatments, but this was severe after only 2%. Antibodies to botulinum toxin were detected in the serum of three out of the five patients in whom loss of treatment efficacy occurred. We conclude that botulinum toxin treatment is the most effective available therapy for spasmodic torticollis and practical advice is provided for anyone wishing to set up the technique.
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PMID:Botulinum toxin treatment of spasmodic torticollis. 774 82

Benign tumors of the cervical spine are relatively infrequent but have a number of common characteristics that aid in the evaluation and treatment of these lesions. The tumors are most common in the first and second decades of life, presenting as pain, neck stiffness and torticollis. In approximately 70%, the lesions are visible on plain roentgenograms and the remainder are well visualized on bone scan and computed tomographic scan. The majority are present in the posterior elements and may be treated adequately with excisional biopsy by curettage. Stage 3 lesions are best treated by marginal excisional techniques and may require adjunctive techniques such as embolization or radiation therapy. The location of the lesion and extent of excision determine the necessity for fusion.
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PMID:Benign tumors of the cervical spine. 144 34

Thirty-seven patients with spasmodic torticollis (cervical dystonia) who received repeated local injections of botulinum toxin have been followed up for a mean period of 12.3 (10-29) months, during which time 138 treatment sessions were performed. Mean doses per muscle averaged 320 mouse units (mu; range 160-1000 mu botulinum toxin A prepared by CAMR, Porton Down, UK). Eighty-six per cent of patients experienced significant improvement of posture and 84% of those with pain had relief following the first injection. Muscular patterns of recurrent torticollis were relatively constant and in most patients efficacy was maintained with subsequent injections, while 15% of all follow-up sessions failed. Only 2 of 37 patients were consistent nonresponders; 22% and 10% of all sessions were complicated by transient dysphagia and weakness of neck muscles, respectively. It is concluded that local botulinum toxin injections can be a safe and efficaceous long-term treatment of spasmodic torticollis and that optimal doses should be between 200 and 400 mu/muscle.
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PMID:Treatment of spasmodic torticollis with local injections of botulinum toxin. One-year follow-up in 37 patients. 154 64

Eleven patients with spinal osteoid osteoma and six patients with spinal osteoblastoma treated between 1975 and 1990 were reviewed to characterize the tumors as they affect the spine and to define the important differences between the two tumors. All patients with cervical osteoid osteoma presented with pain, limited range of motion of the neck, and torticollis. Four osteoblastomas had soft-tissue components in the epidural space, necessitating dissection of the tumor from the dura. No soft-tissue component was found in any of the osteoid osteomas. Our results were similar to a metaanalysis of the clinical, radiographic, and surgical findings of all published cases of spinal osteoid osteoma and osteoblastoma. Important features that have not been emphasized in the literature are the high incidence of torticollis with cervical lesions and the frequent association of epidural invasion with osteoblastoma. Surgeons treating osteoblastoma of the spine should be prepared to dissect tumor from the dura.
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PMID:Osteoid osteoma and osteoblastoma of the spine. 160 80

Eighty-six injections in 49 patients with adult onset spasmodic torticollis were evaluated for efficacy with respect to single point per muscle versus multiple point per muscle injection techniques. Parameters of the syndrome assessed were pain, posture deformity, range of cervical motion, disfigurement, cervical muscle hypertrophy, activity limitation, and degree of involuntary movement. The multiple point per muscle injection strategy appeared superior to the single injection per muscle technique with respect to pain (p less than 0.002, chi-square), posture deformity (p less than 0.001), range of motion (p less than 0.001), and improvement in activity endurance (p less than 0.001). No significant differences were noted with respect to cervical muscle hypertrophy or degree of involuntary movements, although the injections were considered beneficial in both groups to these syndrome components.
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PMID:Botulinum a toxin for spasmodic torticollis: multiple vs single injection points per muscle. 162 92

The effects of buspirone and verapamil on spasmodic torticollis were investigated in two double-blind, placebo-controlled crossover studies. Buspirone was given in doses of 20-100 mg/day for 4 weeks to 14 patients; verapamil was given in doses of 40-100 mg/day for 3 weeks to 8 patients. Neither drug improved symptoms of the movement disorder (posture, motility, rigidity, tremor), pain, perceived stress, or mood, either in the whole group or in any individual patient.
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PMID:Failure of buspirone and verapamil to improve spasmodic torticollis. 162 68

Botulinum toxin has been successfully used to treat spasmodic torticollis. The optimum dosage is not clear and the recommended doses in the United Kingdom are 20-25 ng. We have used much lower doses (average 13 ng) without loss of efficacy and accompanied by a reduction in side effects. We treated 12 patients (eight women and four men) with a mean duration of torticollis of 4 years. Eleven of the 12 patients (91%) showed an improvement in total scores for pain and degree of head movement. The benefits appeared a week after treatment and lasted for 3 months. Side effects were minimal and transient. Our experience suggests low doses of the toxin may be equally efficacious.
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PMID:Low dose botulinum toxin in spasmodic torticollis. 129 May 38

The results obtained in a retrospective study on clinical and pharmacological aspects of 41 patients suffering craniocervical dystonia (24 with blepharospasm, 17 with torticollis) and 11 with spasm are here presented. Mean age of symptoms onset was 57.4, 43.8 and 55.8 years old respectively; this variable was comparatively higher in females than in males with torticollis. The prevalence of blepharospasm and hemifacial spasm was higher in females. A 38.7% of patients suffering blepharospasm also presented oromandibular dystonia (Meige's syndrome). Other abnormal movements less frequently associated were cephalic tremor, postural hand tremor and larynx dystonia. In three cases with blepharospasm there was family history of Parkinson's disease and in two cases with torticollis there was family history of essential tremor. The mean age of onset was lower in patients with clonic torticollis and the evolution time of symptoms was longer than in those who presented the tonic type. Clonic torticollis were less frequently associated to pain. Trihexyphenidyl (anticholinergic) was the most efficient drug in craniocervical dystonia, and clonazepam in facial hemispasm. In general, as earliest the age of onset was, as better the therapeutical response was.
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PMID:[Craniocervical dystonia and facial hemispasm: clinical and pharmacological characteristics of 52 patients]. 176 88


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